PERSISTENT SYNOVITIS TREATED WITH RADIATION SYNOVECTOMY USING Y-90 - A RETROSPECTIVE EVALUATION OF 83 PROCEDURES FOR 45 PATIENTS

The objectives were to investigate the efficacy and safety of yttrium- 90 colloid (Y-90) synovectomy in joints with persistent synovitis and to examine the effect of a second synovectomy using a double dose afte r an initial inadequate response. Of the 45 patients at the University Hospital Utrecht who underwent Y-90 synovectomy between July 1987 and October 1995, the effectiveness and side-effects of all yttrium proce dures (n = 83) were assessed retrospectively. Glucocorticoids were adm inistered together with the yttrium, except in 1987. Radiation synovec tomy had an overall success rare of 75% (complete or almost complete r emission of synovitis) initially, i.e. within 1 month of the procedure , partly due to co-administration of glucocorticoids. However, in Octo ber 1995, only 17 joints (22%) were still in remission with a mean (S. D.) duration of remission of 20.8 months (22.0), range 1-95 months (me dian 16 months). In 60 joints (78%), synovitis was present at that tim e because of an unsatisfactory initial response to the Y-90 injection (19 joints) or recurrent synovitis during follow-up (41 joints); the m ean (S.D.) duration of remission of these 60 joints was 3.3 months (5. 9), range 0-22 months. A second injection of a double dose of Y-90 aft er an initial inadequate response (n = 8) did not contribute significa ntly to a better result. Short-term side-effects occurred in:two cases after two Y-90 injections (2%) without glucocorticoid co-administrati on: a post-injection Rare-up of synovitis and a local skin burn lesion . Persistent synovitis can be treated by Y-90 synovectomy with an over all success rate of 75% within 1 month. However, prolonged remission o f synovitis is only achieved in 29% of joints with a good initial resp onse. It does not appear worthwhile to perform a second synovectomy wi th a double dose if the initial response was inadequate. Y-90 synovect omy leads to only minor short-term side-effects (2%).